How to Treat Heartburn?

Usually at night, we may feel a sour liquid in our throat coming from beneath or burning sensation in our upper tummy. The pain goes up through our chest to the throat. Sometimes we fear it as a heart attack. This is called heartburn or gastroesophageal reflux disease (GERD) in medical terms.

How Does It Happen?

The food we eat starts getting digested right from the mouth up to the large bowel. Food passes through the mouth to the throat and then food pipe, stomach, small and large bowels, rectum and at last excreted as feces. Every part of the digestive system plays its role in digesting food. Stomach is unique from other parts as it has acid in it. Yes, stomach produces hydrochloric acid (HCl). This helps in digestion and also kills germs that may be present in unhygienic food.

The hydrochloric acid is present only in the stomach. A functional valve at the lower end of the food pipe called the lower esophageal sphincter preventes the reflux of acid back into the food pipe. It remains closed most of the time and opens for a short time while we swallow food or liquid and then closes again. Sometimes, it opens for short times even without food, to eliminate the air that is swallowed or gas that is produced by some chemical reactions in the stomach. These transient openings are for very short periods. In some individuals, the openings of this valve are recurrent or for longer duration. In that case acid may come back into the lower part of the food pipe and cause burning of walls of the pipe. This causes pain or burning sensation and it is due to acid reflux.

Risk Factors of Acid reflux:

Some common risk factors of acid reflux are as follows:

Obesity.

Binge eating.

Lying down just after eating.

Taking lot of coffee, tea and citrus juices.

Taking some medicines that contain acid such as Aspirin and medicines that loosen this valve, for example nitrates.

Tight fitting clothes.

With some medical conditions such as hernia, in which a part of our stomach is pulled upwards into the chest.

Heartburn is very common. Most of us experience it three to four times per month. Unless you do not have danger symptoms, this condition is of no concern. Danger symptoms or red flags are weight loss, persistent vomiting, blood vomiting, black colored feces and difficulty in swallowing. If you experience these danger symptoms, then go straight to your doctor without delay.

Investigations:

Usually no investigations are required, but sometimes when the diagnosis cannot be made, few investigations are done to check acid reflux.

1. Esophageal Manometry:

In this, a probe is inserted into food pipe’s lower end, which measures its pressure. If it is decreased, then it causes acid to reflux back.

2. Monitoring Ph:

In this also, a pH probe is inserted into the food pipe through mouth to measure pH of the food pipe continuously for 24 to 48 hours. If it is less than 4, then it gives clue to acid reflux. Normal pH is around 6. This test is also called Bravo test.

3. Endoscopy:

In this test a flexible probe is passed through the mouth to the stomach, which has a camera to view inside the food pipe and stomach. It is also used to remove a small piece of tissue from there to test, which is known as biopsy.

4. Acid Suppressing Medicines:

Sometimes a medicine that suppresses acid production is given and if there is symptomatic improvement, then the treatment will be continued.

Treatment:

Antacids: As we know acid is neutralized by alkali, an alkaline medicine is given. Usually Sodium bicarbonate (baking soda) and Magnesium bicarbonate is used to neutralize the acidic environment. It gives relief in a very short time.

Usually there are no complications of acid reflux, but rarely may arise. There may be stricture formation in which the lower end of food pipe is narrowed or blocked thus causing pain and difficulty following swallowing especially solid foods.

If acid reflux remains for a long time, there appears some changes at the microscopic level in our food pipe that sometimes are precancerous and later may lead to cancer. Do not worry as the chance of it is very less.

An ulcer may develop in food pipe due to longstanding damage from acid.

Sometimes, the acid along with liquid we had drunk short time ago refluxes up to the throat and mouth. It may cause decay of tooth enamel and if this sour fluid goes into the windpipe (trachea), especially if reflux occurs during sleep can cause pneumonia that is inflammation of the lungs.

Preventive Measures:

If you suffer from recurrent heartburn, then the following steps may be taken to decrease or prevent further episodes.

Do not eat full stomach. Avoid fatty foods, excessive coffee, tea or other caffeinated beverages.

Stop smoking and drinking. Do not wear tight clothes.

Don't go to sleep just after having meal. Go to bed about 2 hours after meal. Keep the head end of your bed about 6 to 8 inches above the foot end, so that acid may gravitate down.

Do not have acidic foods such as lemon, orange and tomatoes. Avoid acidic medicines such as Aspirin or medicines that cause more reflux such as nitrates, with your doctor's advice.

Answer:
Hello,
Welcome to icliniq.com.
I went through your query. There are no drug interactions between Pantoprozole and Diclofenac (Voltaren). In fact, anyone who takes painkillers like Diclofenac has to take Pantoprazole to prevent Diclofenac-induced gastritis. So, relax and take the regular dose of Pa...
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Hello,
Welcome to icliniq.com.
It is likely an upper respiratory tract infection, probably viral. You may need antibiotics like tablet Azithromycin 500 mg once a day along with some antacid like tablet Pantoprazole 40 mg before breakfast once a day for five days. Also, you can take Betadine gargle...
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Omeprazole for gastritis like symptomsQuery:
Hi doctor,
I have suffered from gastritis-like symptoms for about a week now. I have an occasional mild tummy ache and nausea which is relieved by belching. I have suffered from acute gastritis now for several years, although I cannot be 100 % certain why. I tested positive for the h. pylori bacteri... Read Full »

Answer:
Hello,
Welcome to icliniq.com.You seem to be suffering from irritable bowel syndrome (IBS) associated with gastritis. Yes, you can take Omeprazole 20 mg. Once a day would be enough. There are no major side effects. There is no indication for taking triple therapy for h.pylori again. I advise the fol...
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I feel bloated and breathless. Is this normal?Query:
Hello doctor,
I have been having stomach problems for the past three days and I have been trying everything and not seem to work. Today I tried Zantac 150 and I feel really bloated and feel like I am out of breath. Is this normal? Please help. Read Full »

Answer:
Hi,
Welcome to icliniq.com.
I understand your concern. Bloating could be due to indigestion issues. Zantac (Ranitidine) will help reduce the acidity of the stomach but not immediately. Take antacids after the meal and at bedtime. Plus, take enzyme digest to help ease digestion, together with Simet...
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Does Omeprazole 20 mg have side effects?Query:
Hello doctor,I have been suffering from symptoms of gastritis now for over a week. However, I took a capsule of Omeprazole 20 mg, and there seems to be a considerable relief, and I feel a lot better. Is it possible that one capsule can do this? Also, I have read online that Omeprazole can be associ... Read Full »

Answer:
Hello,
Welcome to icliniq.com.
Omeprazole is a proton pump inhibitor. It will decrease the acid production in the stomach and relieve the symptoms rapidly.
The worries like pneumonia or so are very very less. It is usually a safe drug.
For more information consult a general medicine phys...
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Is Pantoprazole allergy something to be concerned about?Query:
Hello doctor,
I had indigestion problems last month and I was given a Pan 40 injection in a 24/7 hospital in my locality. The moment I was given the injection, my body developed rashes, redness, and itching. My doctor immediately gave Avil injection after which rashes and redness subsided. Two days... Read Full »

Answer:
Hello,
Welcome to icliniq.com.
I have gone through your question and I understand your concerns but yes Pantoprazole allergy is a permanent condition that you will need to report to any doctor you visit before prescribing medications.
Also, this allergy is nothing to worry about as long as you av...
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